death by drugs - colorado health institute

Death by DrugsColorado at Record High

APRIL 2018

Death by DrugsColorado at Record High

CHI staffers contributing to this report

• Jaclyn Zubrzycki, lead author

• Eli Boone

• Brian Clark

• Chrissy Esposito

• Cliff Foster

• Deborah Goeken

• Liana Major

• Teresa Manocchio

• Ardian Nava

3 Number of Drug Deaths Head Higher, Rate of Deaths Levels Off

4 Numbers of Overdose Deaths: El Paso County Recorded Most in State

4 Rates of Overdose Deaths: Huerfano, Other Small Counties Experience High Rates

5 Colorado Drug Overdose Death Rates

7 The Rise of Opioids

8 Small Population, Big Problem

9 Policy Options

9 Conclusion

9 Methodology

Colorado Health Institute 3

APRIL 2018

Death by Drugs: Colorado at Record High

Drugs are killing more Coloradans than ever. Opioids, methamphetamines, cocaine and other substances claimed the lives of 912 Coloradans in 2016, an all-time high, according to the Colorado Department of Public Health and Environment (CDPHE).

That’s more than the 627 Coloradans who died in a car crash in 2016 and more than the 532 who died of flu that year.

While the suffering is pervasive, it is hitting some areas of the state harder than others.

This paper examines the numbers behind the crisis of a generation.

Number of Drug Deaths Head Higher, Rate of Deaths Levels Off

The numbers keep climbing.

Drug overdose deaths increased by 4 percent, from 880 in 2015 to 912 in 2016. Deaths have more than doubled in the past 15 years: Just 406 Coloradans died of a drug overdose in 2001.

Colorado has set records for drug overdose fatalities in 13 of the past 15 years. And the newest data, while not finalized, shows that trend continuing, with drug overdose deaths climbing to a record high of 959 in 2017.

Colorado’s rate of drug overdose deaths — the number per 100,000 residents — also increased steadily

Key Takeaways

• Colorado recorded 912 drug overdose deaths in 2016, more than in any previous year. And new data, while not final, suggest the deaths increased to 959 in 2017.

• That translates to a rate of 16.1 drug overdose deaths for each 100,000 residents, up 83 percent from a rate of 8.8 in 2001.

• There are wide variations across Colorado’s counties. El Paso County led the state with 141 fatal drug overdoses in 2016, followed by Denver County at 138. Colorado’s populous counties, most located along the Front Range, generally have the highest numbers of overdose deaths, reflecting their larger populations.

• Huerfano County, with about 6,600 residents, had six overdose deaths in 2016. That’s a rate of 152.6 per 100,000, the highest in the state. In fact, nine of the 10 counties with the highest overdose death rates have populations of less than 50,000.

between 2001 and 2015, rising to 16.1 deaths per 100,000 in 2016 from 8.8 deaths per 100,000 in 2001.

Still, it appears that the rate may be leveling off: The death rate in 2016, 16.1, was little changed from 15.6 in 2015 and 15.7 in 2014.

From a national perspective, the U.S. recorded 63,500 drug overdose deaths in 2016 for a rate of 19.8 deaths per 100,000, nearly four points higher than Colorado’s rate.

Figure 1. Drug Poisoning Deaths in Colorado, 1999-2016 n Opioid n Non-Opioid

01999 2003 2007 2011 2012 2013 2014 2015 2016

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423459 430 437 402 408 408

108 137

305379 377 402

468 472 504

912880870839807838728

497345

Source: Vital Statistics Program, Colorado Department of Public Health and Environment

4 Colorado Health Institute

Numbers of Overdose Deaths: El Paso County Recorded Most in State

While the drug overdose crisis is impacting all of Colorado, some counties and regions have been hit harder than others.

CHI examined trends in the greatest number of overdose deaths, generally in urban and suburban counties, and the highest rates of overdose deaths, generally small rural counties, especially in southern Colorado.

Colorado’s more populous counties generally report the highest number of deaths due to overdoses. (See Table 1.) El Paso County led the state with 141 fatal drug overdoses in 2016, followed by Denver County at 138.

Denver County had the state’s highest number of overdose deaths each year from 2001 to 2014. Its overdose deaths peaked at 169 in 2009. El Paso County’s overdose deaths, meanwhile, have increased each year, and it surpassed Denver for the most overdose deaths in 2015.

In some large counties, however, overdose deaths are dropping:

• Adams County had 92 overdose fatalities in 2016, down from a peak of 100 in 2012.

• Larimer County dropped to 39 in 2016 from 61 in 2013.

• And Boulder County fell to 37 in 2016 from a peak of 54 in 2013.

More findings about the number of Colorado drug overdoses between 2001 and 2016 include:

• Overdose deaths tripled in Weld and Douglas counties.

• Mesa County, Colorado’s 11th-largest county and home of Grand Junction, saw a bigger percentage increase in the number of deaths in the past 15 years than other large counties, climbing 440 percent, from 5 deaths in 2001 to 27 deaths in 2016.

• Aggregating data for small rural counties helps paint a picture of what is happening in regions where the state does not provide county-level data due to the small number of deaths.

• Sixteen rural Eastern Plains counties — Sedgwick, Phillips, Yuma, Logan, Washington, Morgan, Kit Carson, Cheyenne, Lincoln, Kiowa, Powers, Bent, Otero, Crowley, Baca and Las Animas — recorded 93 total deaths between 2014 and 2016, up 158 percent from 36 in the three-year period between 2002 and 2004.

• Eight counties in the San Luis Valley — Custer, Huerfano, Saguache, Alamosa, Rio Grande, Conejos, Costilla and Mineral — recorded 29 overdose deaths between 2014 and 2016, more than double the 14 fatalities between 2002 and 2004.

Rates of Overdose Deaths: Huerfano, Other Small Counties Experience High Rates

Rates of overdose fatalities— the number of deaths per 100,000 residents — increased in every region of the state between 2001 and 2016. (See Table 2.)

The most striking increases took place in rural Colorado. Even though many of these sparsely populated counties had a relatively small number of deaths, the high rates signal significant cause for concern. (See Map 1 and Map 2.)

Findings about the rate of Colorado drug overdoses between 2001 and 2016 include:

• Huerfano County, with about 6,600 residents, had six overdose deaths in 2016. That translates into a rate of 152.6 per 100,000, the highest in the state.

Table 1: Counties with Highest Numbers of Fatal Overdoses, 2016

Rank County Deaths Population Rate

1 El Paso 141 690,207 20.4

2 Denver 138 693,292 19.2

3 Adams 92 497,673 18.6

4 Jefferson 91 571,711 16.4

5 Arapahoe 90 637,254 13.8

6 Pueblo 40 165,109 27.7

7 Larimer 39 338,663 11.2

8 Weld 38 294,397 13.3

9 Boulder 37 321,989 11

10 Douglas 33 328,330 10Source: Vital Statistics Program,

Colorado Department of Public Health and Environment


APRIL 2018


Go to coloradohealth institute.org/research

/death-drugs to view an interactive GIF that shows the year-by-year change

in Colorado drug overdose deaths by county from

2001 through 2016.


Colorado Drug Overdose Death Rates

2001Colorado Rate: 8.8 per 100,000

2016Colorado Rate: 16.1 per 100,000

Rate per 100,000

https://www.coloradohealthinstitute.org/research/death-drugs




• Rio Blanco County, with about 6,500 residents, had three deaths, posting the second highest overdose death rate of 52.2 per 100,000. Meeker and Rangely are its largest towns.

• Las Animas County in southeast Colorado, Montezuma County in the southwest Four Corners area, and Rio Grande County in the San Luis Valley rounded out the top five counties for highest drug overdose death rates.

• Pueblo County’s rate increased nearly threefold in the past 15 years to 27.7 deaths per 100,000 people in 2016. Mesa County saw an even more striking increase, rising to 19.8 deaths per 100,000 in 2016 from 4.5 deaths per 100,000 in 2001.

• Again, aggregating data for small rural counties helps paint a picture of what is happening in regions where the state does not provide local data due to the small number of deaths.

• Sixteen Eastern Plains counties — Sedgwick, Phillips, Yuma, Logan, Washington, Morgan, Kit Carson, Cheyenne, Lincoln, Kiowa, Powers, Bent, Otero, Crowley, Baca and Las Animas — had an overdose death rate of 20.6 per 100,000 residents

Table 2: Top 10 Overdose Death Rates By County, 2016

Rank County Deaths Population Rate

1 Huerfano 6 6,642 152.6

2 Rio Blanco 3 6,497 52.2

3 Las Animas 8 14,082 50.9

4 Montezuma 10 26,906 42.8

5 Rio Grande 4 11,424 38.5

6 Conejos 3 8,039 34.9

7 Fremont 15 47,487 30.2

8 Pueblo 40 165,109 27.7

9 Logan 6 22,047 24.5

10 Routt 6 24,679 23.2

between 2014 and 2016, higher than the 15.8 statewide death rate for that three-year period.

• Eight rural south-central counties – Custer, Huerfano, Saguache, Alamosa, Rio Grande, Conejos, Costilla and Mineral – had an overdose rate of 21.6 per 100,000 between 2014 and 2016, also higher than the statewide rate.

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15 15 105

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Adams Arapahoe Boulder Denver Douglas El Paso Jefferson Larimer Pueblo Weld Mesa

Figure 2. Change in Drug Overdose Deaths in Colorado’s Biggest Counties, 2001-16

n 2001 n 2016




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Heroin Prescription Opioids Methamphetamines Cocaine

The Rise of Opioids

Opioids — including prescription painkillers and heroin — are a major driver of Colorado’s increase in drug overdose deaths. The 504 overdose deaths from opioids in 2016 accounted for more than half (55 percent) of the drug-related deaths, up from about a third (32.5 percent) in 2001. (See Map 3.)

Some Colorado counties are disproportionately impacted by the opioid crisis.

It’s particularly acute in Pueblo and other southern Colorado counties. While the state as a whole saw a rate of 8.8 deaths due to opioids (including prescription drugs and heroin) per 100,000 residents between 2014-16, Huerfano and Las Animas counties had more than 20 deaths per 100,000 residents, and Pueblo experienced 15 deaths per 100,000 residents in that time period.

Denver and surrounding metro area counties, El Paso County, and several mountain counties also

had higher-than-average rates of deaths due to opioids, and, reflecting their larger populations, recorded the largest number of deaths in that time period. Denver lost 249 people due to an opioid or heroin overdose between 2014 and 2016, and El Paso County lost 209.

Figure 3. Number of Drug Poisoning Deaths in Colorado by Drug Type, 2001-2016*

Map 3: Opioid Death Rates Per 100,000 Residents By County, 2014-16

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2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Source: Colorado Department of Public Health and Environment

* Categories are not mutually exclusive (may total to more than 100% of total drug overdoses) or comprehensive (other drugs not listed).

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Huerfano County Has State’s Highest Overdose Rate – and That’s No Surprise to Huerfano County

Walsenburg, the largest town in Huerfano County, prides itself on its history as a coal town, though

its last mine shut down in the 1950s.

Today, there are few job opportunities in Walsenburg and the surrounding county, which sits between Pueblo and Trinidad in the shadow of the Spanish Peaks.

Huerfano is one of the poorest counties in the state. It also has Colorado’s highest rate of drug overdose deaths: Six people died of an overdose in 2016. That may not sound like many deaths, but in a county with just 6,640 people, that translates to a rate of 152.6 deaths per 100,000 residents.

For better and for worse, that rate doesn’t come as a shock to residents of this rural Colorado county just south of Pueblo.

“Data goes back for over a decade showing Huerfano as having some of the worst overdose rates in the country,” said Vic Meyers, who works for the Las Animas-Huerfano County District Health Department.

“It’s not a surprise.”

In fact, Huerfano County — in a first for a local government in Colorado — is suing the nation’s top pharmaceutical companies and distributors, claiming that its residents were induced to take opioids for pain management.

Meyers, Huerfano County’s coordinator for Communities That Care, a substance use and violence prevention program focused on youth and funded by the state, said that the opioid crisis is confounding for local leaders.

“The good news is when you talk to a county commissioner or city councilmen or Joe on the street,

and you say, ‘We have a serious drug problem,’ everyone’s in agreement,” he said.

“The bad news is . . . nobody believes it can get better.”

Huerfano County faces challenges common to many rural areas: A downturn in business activity has eaten into the property tax base, leaving less money for substance use prevention and treatment even as more people are using drugs. There are no addiction recovery centers in the county and few programs to deter drinking and drug use by young people.

There are some unique factors at play as well. For instance, Walsenburg disbanded its police department in 2016, leaving all enforcement up to an already-overtaxed county sheriff. And the illegal drug trade of substances, including heroin and methamphetamines, is a significant concern in this region of the state.

Meyers is concerned about the lack of funding and resources targeting his region.

“Our challenge is, we’re kind of forgotten,” he said. “We’re definitely forgotten. We need state leaders to do a better job recognizing the value of our community.”

While programs like the state-funded Communities That Care are a good first step, he said, “we need people to come down here and say, ‘Things can be better,’ to put some effort into improving conditions in rural Colorado.”

Small Population, Big Problem

“Our challenge is, we’re kind of forgotten.

We’re definitely forgotten.”

Vic Meyer, Communities That Care Coordinator


APRIL 2018


There is some good news: Since 2007, overdose deaths due to prescription opioids have been leveling off. In 2016, 300 people died of an overdose due to a prescription, down from a high of 338 in 2014. This trend is most likely occurring as physicians become more mindful about prescribing opioids.

But there could be a downside to this trend. Coloradans with a dependence on opioids may be turning to heroin, which is becoming cheaper and more readily available. In 2016, 228 Coloradans died of a heroin overdose, up from 160 in 2015 and just 21 in 2003. Early numbers suggest that trend continued in 2017.

While the opioid crisis has been at the center of the state and national discussion, Colorado overdose fatalities due to other substances also have increased since 2001. (See Figure 3.)

Deaths due to methamphetamines, for example, increased consistently in the past 15 years. Colorado saw 196 deaths due to methamphetamines in 2016, up from 139 in 2015 and just 22 in 2001. This trend is likely connected to the increase in heroin overdoses, as the drugs are often sold together.

Policy Options

The overdose crisis is the result of a complex set of dynamics, including the development, promotion and over-prescribing of potent legal painkillers, easy access to substances through the illegal drug trade, and diverse personal, social and economic pressures.

It can be difficult for policymakers to know where to target limited resources.

Will statewide programs and policies be most effective? Should the focus be on opioids or should other substances receive targeted attention? Should policymakers target regions with the highest numbers of overdose deaths — primarily the urban Front Range counties? Or should there be more attention paid to the highest rates of overdose deaths — mostly rural counties?

Colorado lawmakers are hard at work on some potential policy changes.

An interim committee focused on opioids and substance use developed six bills for the 2018 session. Five are still active as of March 2018. They range from

requiring Medicaid to cover residential treatment for substance use to allowing school-based health centers to apply for funds to address substance use.

But a problem this complex will require multisector solutions extending beyond the legislature.

Medical professionals are changing prescribing practices and searching for alternative approaches to treating pain. Health policy experts are working to ensure people have access to the best treatment possible. Law enforcement agencies are addressing the illegal drug trade while also developing solutions for the growing number of people in their custody who are addicted to drugs. Social workers, schools and courts tend to the children and families struggling with the consequences of overdose deaths and substance use. And other community organizations are working on prevention and addressing the factors that lead people to seek substances in the first place.

Conclusion

Colorado lost 912 people to drug overdoses in 2016. Each person had a story. But each is part of a bigger picture as well. Deaths due to drugs are increasingly, and distressingly, common across Colorado. While each community is unique, no region is immune.

As Colorado confronts the drug overdose crisis, this analysis is a reminder of the thousands of Coloradans who have lost their lives to drugs in the past 15 years, and the families and communities that have been affected by substance use and addiction.

Methodology

The Colorado Department of Public Health and Environment’s Vital Statistics Program provided the data for this paper.

This analysis uses age-adjusted death rates (deaths per 100,000 residents). Because different diseases or causes of death may be more likely to occur in certain age brackets, it is helpful to age-adjust to prevent data from being biased simply because a population skews older or younger.

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Notes


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The Colorado Health Institute is a trusted source of independent and objective health information, data and analysis for the state’s health care leaders. The Colorado Health Institute is funded by the Caring for Colorado

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